Evaluation of the Patellofemoral Joint – Anterior Knee Pain

The term “anterior knee pain” is a generic description for various types of pain involving the patellofemoral joint. Similar to the use of the term chondromalacia patella, it is a relatively generic term which does not give any specifics about the anatomic structures involved with a particular joint pathology.

Many causes of anterior knee pain are due to a muscle imbalance between the quadriceps musculature, which is usually weak, and the hamstrings musculature, which is usually tight. The tight hamstrings can cause extra stress on the anterior knee structures as the knee strives to achieve full extension against these tight hamstrings. When this is combined with a less than ideally balanced quadriceps musculature, it can cause irritation with several of the anterior knee structures resulting in pain and dysfunction.

The most common cause of pain over the anterior aspect of the knee is irritation of the medial suprapatella plica. In addition, bursitis at the hamstring attachments areas (pes anserine bursitis, semimembranosus bursitis, or FCL-biceps bursitis), patellar tendon mechanism pain secondary to tight hamstrings or other causes (patellar tendinosus, Osgood-Schlatter’s irritation or deep infrapatellar bursitis, scaring of the retropatellar fat pad due to injury or surgery, other scaring in the patellofemoral joint or general pain and inflammation of the joint due to localized or generalized arthritis).

In addition, lateral patellar instability secondary to patellar subluxation or dislocation due to injury, malalignment, trochlear dysplasia, or muscle imbalance may contribute to irritation of the anterior knee structures. It is also important to assess for this when evaluating the patellofemoral joint. Medial patellar subluxation or dislocation can also occur, but is usually due to a lateral release, with the resulting medial patellar instability occurring in the initial 0°-30° flexion arc of the knee.

The usual treatment options for patellofemoral dysfunction involve a combination of low impact exercising, possible use of anti-inflammatory medications, bracing and the judicious use of injections. It has been well demonstrated that a knee and hip strengthening program is very beneficial to alleviating anterior knee pain. The types of exercises to include hamstring stretching can also be determined during the physical exam. McConnell taping may also be indicated to assist with the diagnosis of a problem especially if there is medial or lateral patellar instability.

The majority of patients who do have anterior knee pain structure irritation do respond well to a well guided rehabilitation program. However, it is important to define the exact source of the pain is to help guide this rehabilitation. In those patients who do not respond to this rehabilitation program, a re-evaluation may be necessary to determine if a change in rehabilitation or other treatment modalities may be needed.

Learn How We Can Help You Stay Active

Robert LaPrade, MD, PhD has specialized skills and expertise in diagnosing and treating complicated knee injuries. He has treated athletes at all levels, including Olympic, professional and intercollegiate athletes, and has returned numerous athletes back to full participation after surgeries. Recognized globally for his outstanding and efficient surgical skills and dedication to sports medicine, he has received many research awards, including the OREF Clinic Research Award considered by many a Nobel Prize in orthopedics. Dr. LaPrade is one of the most published investigators in his field, and many of the surgeries that he has developed are now performed worldwide and recognized as the “gold standard” for the treatment of complex knee injuries.

I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. Previous attempts to make it better provided only temporary relief. (including injections and arthroscopic surgery), I heard Dr. La Prade was going to practice in the Twin Cities - where I live, & waited for him, based on his renown reputation. I am so glad I did! Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. I am 5-months post surgery, and am doing great, stationary biking and exercising every day, no pain.You know you are seeing the best when you find out he has written over 500 medical journal articles - among many other accomplishments. Hey - if he is good enough for Olympic and professional athletes…..he's good enough for me! Thank you, Dr. LaPrade, for treating me with the care, focus, and expertise as if I was an Olympic athlete!- From your 63 year old very appreciative patent ~

Dr. Robert F. LaPrade operated on my right knee in May of 2010. I was hit by a car on my bicycle near Horsetooth Reservoir in CO. I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. I could not bear weight on my right side though I tried repeatedly, but finally I went and got an MRI and one of the orthopedic surgeons that I worked with was shocked when he saw the MRI result. My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. I was told by one of the orthopedic surgeons that I worked with that I would never run again and would be lucky if I could ever hike again. This was devastating news after being a top triathlete (3rd in the world in my age group in 1989 & 1st nationally in my age group) and a big marathon runner. All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. I can run, bike, & climb mountains. In fact 2 years ago I finished climbing the top 100 peaks in CO.

RELATED LINKS

Physician Rating

I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. Previous attempts to make it better provided only temporary relief. (including injections and arthroscopic surgery), I heard Dr. La Prade was going to practice in the Twin Cities - where I live, & waited for him, based on his renown reputation. I am so glad I did! Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. I am 5-months post surgery, and am doing great, stationary biking and exercising every day, no pain.You know you are seeing the best when you find out he has written over 500 medical journal articles - among many other accomplishments. Hey - if he is good enough for Olympic and professional athletes…..he's good enough for me! Thank you, Dr. LaPrade, for treating me with the care, focus, and expertise as if I was an Olympic athlete!- From your 63 year old very appreciative patent ~

"Dr Laprade operated me after my father took me to the Steadman Clinic, and having been operated once before in MX, he rebuilt my knee and made me fully functional since then. A very human Physician, and incredible care." - Galia S.

DISCLAIMER All information contained on the drrobertlaprademd.com website is intended for informational and educational purposes. The information is not intended nor suited to be a replacement or substitute for professional medical treatment or for professional medical advice relative to a specific medical question or condition. (Website Terms and Conditions , Privacy Policy and Industry Relationships) Copyright | Robert LaPrade, MD, PhD | All Rights Reserved